Communication problems may occur after a stroke or brain injury
After a stroke, some people have language or speech deficits (aphasia) that seriously interfere with their ability to communicate. These problems vary depending on the location and severity of the brain damage.
How a Speech-Language Pathologist can help
The speech-language pathologist (SLP) works with the person and his or her family/caregivers as part of a team that may also include doctors, nurses, psychologists and audiologists. The team consults together to evaluate the person and develop an appropriate treatment plan
The SLP completes a formal evaluation of speech and language skills. An oral motor evaluation checks the strength and coordination of the muscles that control speech. Understanding and use of grammar (syntax) and vocabulary (semantics), as well as reading and writing, are evaluated.
Social communication skills are evaluated with formal tests and the role-playing of various communication scenarios. The person may be asked to discuss stories and the points of view of various characters. Does he or she understand how the characters are feeling, and why they are reacting a certain way? The person may be asked to interpret/explain jokes, sarcastic comments, or absurdities in stories/pictures.
The SLP will assess cognitive-communication skills. Is the person aware of his or her surroundings? Does the person know his or her name, the date, where he or she is, what happened to him or her (orientation)? Recent memory skills are assessed, such as whether the main details in a short story are retained.
Executive functioning is evaluated. The SLP assesses the patient’s ability to plan, organize, and attend to details. The SLP may read an incomplete story and ask for a logical beginning, middle, or conclusion. The person may be asked to provide solutions to problems (reasoning and problem solving; for example, “What would you do if you locked your keys in your car? How can this problem be avoided in the future?”).
If problems with swallowing are observed, the SLP will evaluate and make recommendations regarding management and treatment. The focus of this evaluation will be to ensure that the individual is able to swallow safely and receive adequate nutrition. Additional swallowing tests may be recommended as a result of this evaluation.
If necessary, the SLP may also evaluate the benefit of a communication aid or device to express basic needs and ideas.
Motor Speech Disorders
What are motor speech disorders?
Motor speech disorders are the inability to speak properly when constructing sentences or saying single words. The coordination, timing and strength needed to speak words is affected. They are caused by damage to the parts of the brain associated with speaking. The severity depends on the nature of the brain damage.
Dysarthria occurs when the muscles of the mouth, face, and respiratory system become weak or slow moving. The type and severity of dysarthria is dependent upon which area(s) within the nervous system are affected. Signs of dysarthria include slurred speech, speaking softly, slow rate of speech, rapid rate of speech, mumbling, hoarseness, breathiness, drooling, chewing and/or swallowing difficulty.
Types of motor speech disorders
The two main types of motor speech disorders are Dysarthria and Apraxia. Dysarthria is produced from a disruption of muscular control from either the central or peripheral nervous systems. Dysarthria is classified as a neuromotor disorder because it is caused by the interruption of information from the nervous system to the muscles. Muscles of the face and mouth can become weak to the point of moving slowly or can stop moving all together. Some causes of dysarthria can be stroke, cerebral palsy, muscular dystrophy and head injuries. Symptoms of dysarthria include: talking very quietly, slurred speech, poor quality of speech, drooling, etc
Apraxia, also known as “Apraxia of speech” and “verbal Apraxia” is caused by parts brain damage, damage to parts of the brain associated with speech. Subjects with Apraxia of speech know the words they wish to speak, however their brain has problems coordinating the facial muscles used to sound the words properly. As with all motor speech disorders there are different levels of severity with people suffering Apraxia of speech. People suffering Apraxia of speech can display inconsistent errors in speech, difficulty imitating sounds and a slow rate of speech.
Dysarthria vs Apraxia
Dysarthria shows consistant errors in speech. The subject with Dysarthria will exhibit the same amount and types of errors in speech no matter which type of speaking task or materials that are used. Apraxia of speech on the other hand is inconsistent and very unpredictable. Well rehearsed or automatic (learned) speech is easiest to produce, however spontaneous speech more difficult. The number of errors increases as length of the word or phrase increases.
How are Motor Speech Disorders treated?
Treatments vary depending on the patient and severity of the speech disorder. The speech and language pathologists may use many different treatment methods that are specific to each patient. Treatment programs are formulated to focus on the strengths and weaknesses of the patient.